Looking to Policy to Prepare for the Next Outbreak

By Matt Phillion

With outbreaks of measles and bird flu making headlines, now is a great time for healthcare organizations to take a hard look at preparedness and identify risk areas to help better understand transmission and take steps to make sure they can identify and appropriately manage these and other contagious diseases.

“We’ve seen roughly 150 cases of measles this year already, in 21 jurisdictions, with more than 10 outbreaks,” says David Weber, MD, MPH, of UNC Medical Center in Chapel Hill NC, president-elect of the Society for Healthcare Epidemiology of America (SHEA). “This more than last year already, and if you look at measles, it’s the most infectious virus we have.”

The basic reproduction number (R0) of measles—which indicates susceptibility and transmission of an infectious disease—is staggering. A person with measles would, by this standard, be expected to infect 12-18 people, compared to two to four people for SARS or the flu, for example.

“It’s so infectious that if someone comes into a waiting room or doctor’s office, two hours after they leave someone could still get measles. That’s not true for COVID, the flu, or RSV,” says Weber.

The more infectious a disease is, the higher the number of people who must be immunized with a very effective vaccine to prevent an outbreak. For measles, we need the vaccination rate to be at 95% to work.

“In many parts of the country, because of pushback over vaccines and concerns about COVID, the percentage people not immune to measles is greater than 5%, and not surprising, almost everyone who gets the measles has not been immunized,” says Weber. “In the coming months and years with more cases and small outbreaks, I worry that if we see more failures of people to get the vaccine, those small outbreaks will become big outbreaks.”

COVID and Avian Influenza

Weber also notes that we continue to see multiple variants of COVID.

“In general, the newer variants have been a little more infectious, and that’s why they spread, but they have not been more virulent—though just because both vaccines and natural immunity give you partial protection against new variants, this doesn’t mean next week we can’t have a new variant that escapes previous immunity,” says Weber.

Healthcare organizations and the public need to stay on top of these changes and remain vigilant as they occur, he explains.

Also top of mind: avian influenza (H5N1) has been making headlines as it continues to spread across the globe.

“We’ve had over 900 human cases transmitted from poultry or wild birds, and more recently from cattle,” says Weber. “In the current outbreak, we have barn cats getting H5N1 and dying from it, and mice have been found to carry it. While it has high mortality and morbidity, it hasn’t picked up the genes to make it transmissible human to human, but all it takes is one gene to allow human transmission.”

With flu pandemics striking every 10 to 30 years historically going all the way back to the 1850s, it’s never a matter of if but when the next outbreak will happen, Weber explains.

“The last one was in 2009 and fortunately in that one the new strain wasn’t more virulent. We could have one like the outbreak of 1918, though,” he says. And of course, there’s nothing stopping another COVID outbreak at any point, so vigilance is the key thing to keep in mind.

“I also worry about existing viruses: Mpox is moldering in the U.S. and Europe, and ongoing small to medium outbreaks of Ebola or other fevers all have substantial morbidity and mortality,” says Weber. “There’s nothing preventing someone from bringing those to the U.S.”

SHEA offers new guidance

To help address concerns and improve preparedness, SHEA has produced five new papers to assist policymakers improve global health resilience. The statements, published in the journal Infection Control and Hospital Epidemiology, look to address the patchwork systems of global and domestic monitoring for the next infectious disease threat, advocating for better funding, more interoperability and coordination, and overall stronger preparedness. The papers draw upon lessons from COVID and offer guidance and education to those in a position to make policy changes to bolster pandemic preparedness.

“The recommendations are really designed for people in Congress, public policymakers in the Senate. It’s a matter of both funding and implementing the things we learned from past pandemics,” says Weber. “Especially Mpox and COVID. We have a lot of examples, and we certainly don’t have a lack of recent examples of what we did right or what we did wrong.”

Key recommendations include:

• Increasing stockpiles of key equipment and improved transparency about those stockpiles
• Increased transparency into events that impact the supply chain
• Rapid and early FDA action to allow non-U.S. approved devices and medications to be imported
• Maintaining a six-month supply of PPE, antiseptics, and more
• Prioritized management strategies for N95 respirators and single-use gloves
• Funds to assist with identification of mis- and disinformation
• Support for research into health communication strategies
• Development of communication strategies that can express uncertainty without undermining trust

It’s a matter ensuring funding and coordination to enable the implementation of strategies we know will reduce illness and death, Weber explains.

“There are bills pending in Congress to provide additional funding for pandemic planning and research,” says Weber. “I’d love to see those pass to help improve our pandemic infrastructure. This isn’t a Democrat or Republican issue—these viruses kill everyone indiscriminately.”

There can be a bit of out of sight, out of mind mindset when it comes to this issue, however.

“More people died of COVID last year than gun violence or car crashes,” he says. “The key to controlling any of these diseases is ensuring clinicians recognize them and properly isolate the patient so other patients and providers aren’t infected.”

Weber also advocates that the necessary testing is available at the local level so that swift action can be taken when it is needed.

“We believe some antiviral agents would have some effect against infection, but you have to give the patient the drug before they develop the disease. You’ve got to diagnose the persona and provide prophylaxis for other people. This is why we need local tests that are sensitive and specific,” says Weber.

While looking at preparedness on the national level, Weber notes that there is a lack of transparency about what the country’s national stockpile of pandemic equipment and tools contains.

“We had shortages of so many things during COVID, and while we have a national stockpile, it would be nice to know what they have, so we can pre-train,” he says. “NIOSH and OSHA require us to do fit tests for someone using a respirator, but if we don’t know what type of respirator we’re using, how do we fit test them?”

More transparency about the tools and resources available can only help improve preparedness, Weber notes.

“The military is always carrying out planning for what happens if X or Y happens. Most of those scenarios are unlikely, but they plan because if something does happen, they can pull a book off the self and know what to do,” says Weber. “We don’t do that as well in pandemic planning. Passing these bills would help improve that planning.”

While current concerns might focus on avian flu or measles, it’s important to always keep an eye out for “disease X,” Weber says, the not-yet-predicted outbreak or situation.

“You don’t know what you don’t know,” says Weber. “I’m always worried people beginning to plan but don’t have the infrastructure and finances to bring to the level we need. Pandemic planning shouldn’t be political. I wish we’d simply follow the science.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.